Community Pharmacist Utilization of Legislation That Allows Impact on the Opioid Crisis in the State of Minnesota: A Mixed-Methods Approach.

BACKGROUND: As opioid overdose deaths climb, legislation supporting pharmacists in developing their role to address the crisis has expanded. Although Minnesota pharmacists are encouraged to utilize opiate antagonist, syringe access and authorized collector legislation, the use patterns of these tools are unknown. METHODS: A mixed-methods approach was used to survey 8405 Minnesota-licensed pharmacists on their practices related to the opioid crisis. An analysis of community pharmacist utilization of opioid-related legislation was conducted. RESULTS: The majority (88.64%) of respondents indicated that they had not dispensed naloxone in the past month using a protocol; 59.69% reported that they had not dispensed naloxone by any method in the past month. Over sixty percent (60.61%) of respondents agreed they are comfortable with dispensing syringes and would dispense noninsulin syringes in their pharmacy under the statewide Syringe Access Initiative; 25.86% reported that they are not comfortable dispensing syringes. The majority (78.64%) of respondents reported that they do not participate in collecting unwanted pharmaceuticals. CONCLUSION: While pharmacists have the potential to play a key role in efforts focused on addressing the opioid crisis through harm reduction strategies, this role and the use of supporting legislation is currently underutilized in the state of Minnesota.

Community Forums to Address the Opioid Crisis: An Effective Grassroots Approach to Rural Community Engagement.

PURPOSE: With opioid overdose deaths on the rise in rural Minnesota and across the nation, the call for community-based grassroots efforts is stronger than ever. Recognizing that substance use prevention and recovery programming rely upon community resources, collaborative teams planned and implemented a series of nine community forums focused on opioid and heroin use across rural northeast Minnesota to educate and unite invested community members on the critical public health issue. This article examines the outcomes of the forums and the ingredients of a successful forum. METHODS: Surveys were distributed at seven rural community forums to assess measures of growth in knowledge and awareness, as well as demographic characteristics of respondents. FINDINGS: Forums planned by university faculty and community members were effective in increasing overall awareness and knowledge of the opioid crisis within each community. Forums that were rated more highly by attendees included speakers from varied professional backgrounds and integrated cultural strengths. Communities that planned forums together have reported increased collaboration to prevent and address substance use and increased community member engagement on local grassroots coalitions since the time of the forum. CONCLUSIONS: Community forums have functioned as an effective grassroots approach to engaging rural community members in opioid use prevention and intervention efforts.

Assessing pharmacy student experience with, knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction.

BACKGROUND: As the burden from the opioid epidemic continues to increase in the state of Minnesota and across the nation, the University of Minnesota College of Pharmacy seeks to design an innovative, comprehensive harm reduction curriculum in order to better train student pharmacists to serve the varied needs of the greater community. This study examines incoming individuals' baseline knowledge of and attitudes toward harm reduction in order to better inform curriculum planning and to ultimately produce pharmacists capable of impacting the devastating effects of the opioid crisis. METHODS: Incoming first-year pharmacy students took a survey focused on their knowledge of opioid overdose and the drug naloxone and also provided written reflections on their perceptions of harm reduction. Data was coded using consensual qualitative research (CQR) into appropriate domains. RESULTS: Pharmacy students beginning their professional education revealed a lack of knowledge of proper response to an overdose situation, with 18.56% unfamiliar with the opioid antagonist drug naloxone. Close to 10% (9.58%) of students expressed unwillingness to do anything other than call an ambulance during an overdose event, while 8.98% were either unsure or felt that they would not feel compelled to do something to help. Qualitative coding revealed many barriers to students' becoming capable harm reductionists, including lack of knowledge of substance use, addiction, and harm reduction, in addition to the presence of bias and stigma. CONCLUSION: In order to interrupt the cycle of misinformation and stigma within the larger community and the subgroup of medical providers, gaps in student knowledge must be addressed in meaningful, specific ways over the course of their pharmacy education. Evaluating baseline knowledge and beliefs informs the design of a flexible, action-oriented curriculum to produce well-trained pharmacists ready to engage in finding solutions to the opioid crisis.

Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat.

It has been reported that daily fluid intake influences urinary dilution, and consequently the risk of urolithiasis in human subjects and dogs. The aim of the present study was to investigate the role of dietary moisture on urinary parameters in healthy adult cats by comparing nutritionally standardised diets, varying only in moisture content. A total of six cats were fed a complete dry food (6.3 % moisture) hydrated to 25.4, 53.2 and 73.3 % moisture for 3 weeks in a randomised block cross-over design. Urinary specific gravity (SG), urine volume, water drunk and total fluid intake were measured daily; relative supersaturation (RSS) for calcium oxalate (CaOx) and struvite was calculated using the SUPERSAT computer program. Cats fed the 73.3 % moisture diet produced urine with a significantly lower SG (P < 0.001) compared with diets containing 53.2 % moisture or lower. Mean RSS for CaOx was approaching the undersaturated zone (1.14 (sem 0.21); P = 0.001) for cats fed the diet with 73.3 % moisture and significantly lower than the 6.3 % moisture diet (CaOx RSS 2.29 (sem 0.21)). The effect of diet on struvite RSS was less clear, with no significant difference between treatment groups. Total fluid intake was significantly increased (P < 0.001) in the 73.3 % moisture diet (144.7 (SEM 5.2) ml, or 30 ml/kg body weight per d) compared with the 6.3 % (103.4 (SEM 5.3) ml), 25.4 % (98.6 (SEM 5.3) ml) and 53.3 % (104.7 (SEM 5.3) ml) moisture diets, despite voluntary water intake decreasing as dietary moisture intake increased. Cats fed the 73.3 % moisture diet had a higher total daily fluid intake resulting in a more dilute urine with a lower risk of CaOx when compared with the lower-moisture diets.

Energy requirements of adult cats.

A meta-analysis was carried out in order to establish the energy requirements of adult cats. Publications that identified cat body weight (BW) were used to generate allometric relationships between energy requirements and BW of healthy adult cats, using log-log linear regression. Energy requirements were expressed in kcal/kg BW to be consistent with those reported by the National Research Council. Mean maintenance energy requirements were 55.1 (se 1.2) kcal/kg BW (115 treatment groups). Three allometric equations were identified to predict the energy requirements for maintenance of BW in the cat based on BW: light (53.7 kcal/kg BW- 1.061), normal (46.8 kcal/kg BW- 1.115) and heavy (131.8 kcal/kg BW- 0 .366). When reported on lean mass, the allometric equation revealed maintenance requirements were 58.4 kcal/kg lean mass- 1.140 (adjusted R2 0.694; thirty-six treatment groups). The present review suggests that values for maintenance energy requirements based on BW alone may not be an accurate prediction and more detailed information on the age, sex and neuter status, BW and composition would enhance the ability to interpret the maintenance energy requirements of cats.